Note: This article contains subject matter related to suicide. If you or someone you know is struggling with mental health, call or text the 988 Crisis Support Lifeline to speak with a trained mental health professional.
SPOKANE, Wash. — Newly released documents from the Department of Health reveal significant patient safety risks at Providence Sacred Heart Medical Center that affected four patients with suicidal ideation, including a 12-year-old girl at the center of a wrongful death lawsuit.
The Notice of Immediate Jeopardy element of the DOH investigation found, “the hospital failed to develop and implement effective policies and procedures for caring for four out of eight patients who were identified to have suicidal ideation (SI) during their admission and failed to ensure that staff provided a safe environment for patients with SI.”
This notice was issued on April 30, more than two weeks after 12-year-old Sarah Niyimbona’s death. Providence submitted a safety plan and the following day the immediate jeopardy status was subsequently lifted.
In a statement to 4 News Now, Providence said: “Following a tragic incident, Providence launched an internal investigation and self-reported to health authorities, prompting an external investigation. Providence implemented improved protocols and trainings, which included screening all patients for potential suicide risk and responding to situations when patients go missing while hospitalized. Providence remains committed to working in close partnership with health authorities on this issue.”
Providence declined 4 News Now’s request for interview, citing patient privacy, and provided the following statement:
“At this time, we cannot share specifics due to patient privacy laws other than to say we are working in close partnership with all relevant health authorities to address the situation.”
The DOH documents also provide more details about the sequence of events leading up to the day Sarah jumped from the fourth floor of the hospital parking garage.
According to the wrongful death lawsuit filed by Sarah’s mother, both the nurse monitoring Sarah’s door and the video camera monitoring device were removed in the weeks before her death.
The Department of Health investigation found “no evidence of a provider or mental health provider assessment or documentation of recommendations for the downgrade.” It further states that interviews with nursing and security staff indicated they were “uncomfortable with the decision” to remove an observer. At that time an alarm was placed on Sarah’s door.
The documents give new information about several self-harm attempts Sarah made while hospitalized before her death, including another incident where she left her hospital room and reached an elevator. According to the DOH, before Sarah’s death she had written specific details that led health professionals to recommend continued suicide and self-harm precautions.
RELATED COVERAGE: “They failed my daughter”: Mother seeks answers for teen’s death at Sacred Heart
Dr. Cory Alexander, a board-certified child and adolescent psychiatrist with over 38 years of experience, previously worked inside the Psychiatric Center for Children and Adolescence at Sacred Heart before it closed last year. She emphasized the specific needs of young patients in psychiatric care.
RELATED COVERAGE: Providence shutting down youth inpatient psychiatric care center in Spokane
“First and foremost, there’s physical safety, is the child secure and being monitored,” Dr. Alexander said. “One of the issues that does happen for children that are struggling with suicidal impulses is they come up very suddenly.”
Dr. Alexander explained that these sudden impulses require extensive safeguards: “Can you get out of the door, do you have access to sharp objects, is there somebody around to talk to—very important.”
She also highlighted the critical importance of relationships with care providers, which can be lifesaving.
“To talk with that child, engage with that child, and work with the side of that child that wants to stay alive. Yes, there’s a huge side that feels hopeless, that’s depressed that wants to end their life, but how do you work and corral that hope?”
The Psychiatric Center for Children and Adolescence at Sacred Heart closed last year, limiting resources for youth mental health care in the region.
Parents concerned about their children’s mental health can submit questions to a mental health expert from the National Alliance on Mental Illness. Questions can be emailed to news4@kxly.com with the subject line “Teens in Crisis.” Experts will answer as many questions as possible during an upcoming broadcast.
Resources for those in crisis:
988: National Suicide Prevention Lifeline
Crisis Text Line: Text HOME to 741741
Frontier Behavioral Health operates a 24/7 crisis line in Spokane, Adams, Ferry, Lincoln, Pend Oreille, and Stevens counties: (877) 266-1818
Idaho Rural Crisis Line: (877) 897-9027
Inland Northwest Behavioral Health (INBH): (509) 992-1888
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